This proposal is in response to PA-07-099 Chronic Illness Self-Management in Children and Adolescents. A pilot intervention is proposed to improve self-management and quality of life of youth with asthma. Poor asthma management practices cost 3.2 billion dollars per year in health care costs. Non-adherence to prescribed protocols is high, with less than half of children following physician's orders. The results of this R21 will inform a full randomized clinical trial and the methodology employed may be applicable to other chronic health conditions such as diabetes and cystic fibrosis. The objectives of the PA are fulfilled by focusing on medical adherence, family functioning, and tailored interventions. The proposal aims to improve family based management strategies by building on daily routines, effecting direct communication between parent and child, and reducing emotional burden of care. First, a series of focus groups will be conducted with 30, 8-12 year old children with persistent asthma and their primary caregivers. Families will be presented a collection of helpful hints of asthma management strategies suggested by 200 families in another NIH study. The hints are framed as part of the family's daily routines and are geared to improve medical adherence. The caregivers and children will complete ratings of acceptability for each of the routines and discuss barriers in adhering to medical regimens. Based on the acceptability ratings and focus group discussions, a set of routines will be identified for a tailored intervention in a primary care setting. Second, 30 children between 8 and 12 years old with persistent asthma and their caregivers will be enrolled in an intervention group. Baseline recordings of medication adherence will be taken for 4 weeks and then reviewed with the child and parent during a primary care visit with a respiratory therapist. The child and caregiver will be presented a menu of routines drawn from the focus group (e.g., using calendars, placing medications by tooth brush, planning for sleepovers) and asked to select six that will fit best with their own barriers and family life. Cards or objects representing the routines will be placed in a Family Backpack for the child to take home. A control group of 30 children with asthma will receive standard asthma education from the respiratory therapist. Three- and six-month follow up will be used to compare the groups on levels of medication adherence, quality of life, and self efficacy. Results of the project will be used to develop a large scale randomized clinical trial in primary care settings serving diverse populations of children with persistent asthma. 7. PUBLIC HEALTH RELEVANCE: Of the nine million children in the United States that were affected by asthma in 2002, four million had an asthma attack and close to one million were seen in emergency departments, while over $3 billion was spent in asthma care. Asthma is a controllable condition and adherence to prescribed medications can reduce expensive health care costs and reduce the number of school days missed due to asthma. This tailored yet practical and feasible intervention aims to increase medical adherence by building on family routines that will make it easier to remember to take daily medications.